Dr. Satish Kumar .V – Consultant Neurology, Fortis Malar Chennai

 

INSOMNIA:

Insomnia is a common sleep disorder that makes it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life. Insomnia simply put is a complicated condition of habitual sleeplessness.
How much sleep is required varies from person to person, but most adults need seven to eight hours a night.At some point, many adults experience short-term (acute) insomnia, which lasts for days or weeks. It’s usually the result of stress or a traumatic event. But some people have long-term (chronic) insomnia that lasts for a month or more. Insomnia may be the primary problem, or it may be associated with other medical conditions or medications. Several external factors like stress, unhealthy sleep habits, and changes in the environment can be the root cause of insomnia. But insomnia can be handled by simple changes in daily habits.
Insomnia symptoms may include:
Difficulty falling asleep at night
Waking up during the night
Waking up too early
Not feeling well-rested after a night’s sleep
Daytime tiredness or sleepiness
Irritability, depression or anxiety
Difficulty paying attention, focusing on tasks or remembering
Increased errors or accidents
Ongoing worries about sleep

If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

Insomnia may be the primary problem, or it may be associated with other conditions.Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.

Common causes of chronic insomnia include:
•Stress: Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.

•Travel or work schedule: Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.

•Poor sleep habits: Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.

•Eating too late in the evening: Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.

Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but the insomnia may persist after the medical condition improves.

Additional common causes of insomnia include:
•Mental health disorders: Anxiety disorders, such as post-traumatic stress disorder, may disrupt your asleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.

•Medications: Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.

•Medical conditions: Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.

•Sleep-related disorders: Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.

•Caffeine, nicotine and alcohol: Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.

Insomnia and aging
Insomnia becomes more common with age. As you get older, you may experience:
•Changes in sleep patterns. Sleep often becomes less restful as you age, so noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.

•Changes in activity. You may be less physically or socially active. A lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.

•Changes in health. Chronic pain from conditions such as arthritis or back problems as well as depression or anxiety can interfere with sleep. Issues that increase the need to urinate during the night ―such as prostate or bladder problems ― can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.

•More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia associated with medications.

Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.
Risk factors
Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

You’re a woman. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disrupt sleep. Insomnia is also common with pregnancy.

You’re over age 60. Because of changes in sleep patterns and health, insomnia increases with age.

You have a mental health disorder or physical health condition. Many issues that impact your mental or physical health can disrupt sleep.

You’re under a lot of stress. Stressful times and events can cause temporary insomnia. And major or long-lasting stress can lead to chronic insomnia.

You don’t have a regular schedule. For example, changing shifts at work or traveling can disrupt your sleep-wake cycle.

Complications
Sleep is as important to your health as a healthy diet and regular physical activity. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well. Also insomnia could lead to neurological disorders that could provoke seizures, increase risk of depression, stroke and cardiac ailments and memory disturbances.
Complications of insomnia may include:
Lower performance on the job or at school
Slowed reaction time while driving and a higher risk of accidents
Mental health disorders, such as depression, an anxiety disorder or substance abuse
Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease
Diagnosis:
Depending on your situation, the diagnosis of insomnia and the search for its cause may include:
•Physical exam. If the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep.
•Sleep habits review. In addition to asking you sleep-related questions, your doctor may have you; complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks.
•Sleep study. If the cause of your insomnia isn’t clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.
Prevention
Insomnia hurts, wrecks your moods and reduces your energy levels and affects your overall performance. Nearly 711 different genes in your body are affected by just one week of mild sleep deprivation. A few lifestyle changes and regular exercise can help to enjoy an undisturbed sleep. Practicing relaxation techniques like yoga, deep breathing, and a regular bedtime routine can help individuals in a speedy recovery from insomnia. While medical intervention is required at an advanced stage of insomnia, exercising regularly helps in prevention or recovery at an early stage. Sleep disorders majority of the time are psychological insomnia which means the worry of getting sleep. Hence proper counseling about regular sleep schedule and reassurance is of utmost importance.